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>> All right. So we were in in-service. And the first thing that I thought was important for you to know if you're being in-service today which you are is that, you know, something about strategic

learning and just reasoning. So we've talked about that. And then this is my bias. This is in my textbook and this is in every presentation that I give because I am so convinced that this is critical

to learning and this is where I think families and teachers, and community members go wrong. So I want to take a little bit of time and involve you in some discussion about this. No matter what you

read about traumatic brain injury and I know you've all read something, you're going to find these characteristics or what are considered underlying processes. And no matter what you read, you will

always find that these are the types of problems our kids are going to have. And so one is they will say there's impaired attention. And so, that's fine. And if you're--if you've been doing any

testing, there's all kinds of tests for attention and what have you. And so if you read a report from a hospital or a rehab person or from the school psychologist, or whatever, you're likely to see

that they're going to say, "Child has impaired attention." All right. That's the underlying process but that is not what you're going to be concerned about in the classroom. What is going to happen

and what I think is missing from everybody's report is the behavior that goes along with that characteristic because it's the behavior that gets identified and it's the behavior, I'm sorry, I blame

the pilgrims when they came over that they were here for all sorts of freedom and then they put people in the square with whatever letters on their head that, "Punish, punish, punish, everything we

do, we punish." And unfortunately, I think in a lot of our schools, we are in the punishment model. We don't even sometimes know we are. But what happens is we don't think about the behavior and

connect it to the process. If we connect it to the process, we wouldn't be punishing the behavior. So I'm going to take a couple of minutes and give you some examples. Let's talk through what I'm

talking about. And in fact there's actually some examples up here. So in your classroom, what does impaired attention look like? Well, the first thing that's up there, it says, "Well, it looks like

daydreaming." So a kid who is off floating off, they're not in a lot of trouble because they're not disrupting the classroom but daydreamers are in trouble because they are not learning, they're not

with you. Okay. So what some other behaviors that you see that would tell you there's an attention problem going on here? What do you see kids doing?

>> Constantly moving their feet or their hands.

>> Okay. So they've got this little extra disinhibited kind of motor movement. Okay. What else tells you that the child is not paying attention any longer?

>> [inaudible]

>> I said looking some place else.

>> Pardon me?

>> They are looking someplace else. They're bothering their neighbor. They're flipping through the book when you haven't asked them to flip through the book, etcetera, etcetera. They are playing with

the materials on the desk. They're doing all the sorts of things that make me as a teacher distract her and go, "She's got to stop it. I got to get that behavior stop." I had a little girl once, her

name was Mary and the IEP said, "Child will stop rocking in the chair." Okay. So now there was no sensory issue. There was nothing going on except that if you would go and sit in the classroom and

watch the--you could see what was going on. And what was going on was she was--you know, the teacher is doing a little five-minute lecture about toothbrushes. And so about three minutes in or

whatever, Maria starts rocking back and forth in the chair and flipping around. And nobody wants her to fall over backwards, they have another brain injury or what have you. But that is not the goal

of the IEP to get her to stop rocking in the chair, right? The goal has to be, what is the underlying process? Well, she was done. She [inaudible] will put up her red flag and when I give up, I can't

listen anymore. I'm done. So once you figured out that the underlying process was attention, then who solves the problem? The teacher because she said, "Well, I've got computer banks over there. The

same exercise that I'm doing, I can just send her over and she can--so she would say, walk over and she go computer time, Maria get up, should go push on her computer. And the activity that the

teacher was teaching came up for Maria, you know, she--it broke the concentration. She was able to move. She walks somewhere else and she started to her a new activity. So the underlying process of

attention becomes a problem. Memory. What--short-term memory is information that's never stored. We keep it long enough to act on it. What do we do in the classroom that requires short-term memory

skills?

>> Everything.

>> Just about everything but mostly it's this, directions, turn to page 42, do the first five problems. When you're done with that, turn in your paper and you can go to the art table. And the kid with

the brain injury, does what?

>> The first thing.

>> The first thing which is called primacy. So they heard the first thing, they'll turn--they'll open the book to the right page, after that, they're done. Or they'll do the last thing which is called

recency. They remember the last thing that they were told to do. Who is in more trouble, the kid who turned the book to the right page or the one who went to the art table?

>> [indistinct chatter]

>> Art table. And in my head, I am not saying, you know, that is short-term memory problem. I am saying, "I have no idea what's wrong with this kid. But when I tell them to do something, he gets up

and he goes over to the art table. He's uncooperative. I can't have this in my classroom. Something has to be done." But not--we're not saying, "Gee, the IEP should be addressing short-term memory."

I need to alter my teaching style. This kid needs it written down. I shouldn't be giving three directions at a time to this one. I should be giving them one at a time. And guess who would that help

in the classroom, by the way, if I gave them one at a time?

>> [indistinct chatter]

>> Yeah. Just about everybody. Okay. So we--you're giving me idea. What is impulsivity look like in a classroom?

>> [indistinct chatter]

>> Just what she just did. Whoohoo. You know, I know the answer of that one. I got it.

>> [indistinct chatter]

>> Yeah. Okay. And remember, the frontal lobe is critical to the injury that most of our kids get. And developmentally, that's an issue as well. The frontal lobe in all of us is your chief chef

executive officer. Your frontal lobe talks to you, and it says, "Don't say that right now. Don't do that right now, okay?" So our kids, they get in trouble socially. Why? Because they say what's in

their head, you know. Every one of us goes, "I can't imagine why that woman has that dress on? Does she never look in the mirror when she goes out? I mean that's ridiculous." But if I have my brain

injury and I'm a kid in your classroom, I'm going to say, "That is the ugliest top I've ever seen."

>> Yeah.

>> Right? And she's thinking, "I hate her." She's not thinking there's a brain injury and she's impulsive and she can't control her thoughts. She's thinking, "Get this person out of my face. She

doesn't like me. She doesn't like what I wear. You don't have to like what I wear, just you're going to have to be in my classroom. I'm going to write you up." Right? Okay? So the behavior has again

influenced the response of the adult and it's a negative response, okay? So we've got our impulsivity. And I'm going to just go ahead with my little--get on my soapbox right now. I can do it now. I

can do it in two more slides, I'll just do it. That includes cursing. How many of you have gone to an R-rated movie lately? Oh come on, put your hands up. You all did. Okay.

>> [indistinct chatter]

>> Hell yes.

>> Huh? Hell yes.

>> Sorry.

>> No, you're absolutely right. You're absolutely right. Why--you voluntarily went to a place where you know you're going to hear really bad language, right? You voluntarily chose to do that. When you

say to a kid, "I'm punishing you for cursing in my classroom," how does this kid even know? Let's face it. Some of these kids come from homes where every sentence that comes out in a communication

contains that language. And so you're the big guy, you can punish it or you can ignore it. Now, I'm not saying you don't work on it but I'm saying that the time that it happens, here's what we

rethought to do, that's inappropriate. You stop saying that. Well, first of all, how does she know it's an appropriate? Because I didn't tell her. And if every language, bad word comes out at my

house all the time, nothing that you just said to me makes any sense.

>> It's how my mom talks to me.

>> It's how my mom talks to me. I don't know what you're talking about. What's inappropriate is the setting? And I don't even like--I--please take inappropriate out of your--out of your vocabulary

because nobody knows what inappropriate is. What's inappropriate to me is not necessarily inappropriate to her, that's your judgment on me. So don't say it. You can say, "I don't like it when you

say," you have to use the word. I don't like it or you don't say that in school. But it's up to you to decide if this person stays in your classroom or go to the office. And guess what happens when

they go to the office. They get suspended et cetera, et cetera and you're down the road of issues that you didn't have to go down. This person has a frontal lobe injury. The behavior is impulsivity.

The underlying process needs to be worked on. It's not a punishable offense and I know--I mean I've heard from teachers everywhere. Well, if I let one kid do it, here's my answer to that. Here's my

answer to that. Your classroom is not a democracy. Your classroom is a dictatorship. And I can say to her, "Don't you dare, you're in my classroom. You and I know each other. You do it, you're in

trouble. She's different. You're different. You're different. You're different. I got different rules for all of you, so don't bother with that. It's not going to work." So, that's just my thing

about impulsivity. You wouldn't punish a kid with a brace on his leg because he couldn't run, but you punish kids with brain injuries who are impulsive about what they're thinking and doing. That's

how I'm thinking about that differently. Okay. Inefficient retrieval of older stored information. This is long term memory. And again we spend all that time on strategic learning, so I'm not going to

go over that again except to say, yeah, I have had teachers say--well, I don't know, you know. He chose not to do well on the test. I reviewed him yesterday. He knew every bit of it and today he

missed half of it. Well, it is my question. Why didn't you test him yesterday? What is the magic about the next day? Test him the day that you--because you know what, that's back to that verbatim

memory stuff which we shouldn't care about for--well, most kids but certainly not these kids we care that they have a base process that they know that addition means it's going to be a bigger number.

That's what we care about. And so when they know that and when they tell you they can do it, then test them on it, please. Okay. So they're poor test takers. They have inconsistent memory. Don't

recall one day and not the next. We had a gal years ago. She was fascinating because she had lost History. And her History teacher thought she was fooling around but she had no recollection or

ability to come back with George Washington or any of the rest of it, she could not do it. But if you ask that teacher at the high school, what do you think the teacher said about the student.

>> Lazy.

>> Lazy, disinterested, doesn't like the topic, doesn't use to study. Well, why would somebody who chose to study everything else choose to not do one thing? It didn't make sense.

>> And so kids like that too would and--because they probably are aware.

>> Why can't I remember that, because then their behaviors. That would be frustrating.

>> Uh-hmm.

>> And so their behaviors are maybe going to become more negative, that'll be--maybe aggressive either because they're frustrated.

>> Uh-hmm.

>> Yeah. And again if I can just pick on you for one little thing...

>> There's another word that is kind of tough for us to use and that's the word frustrated. Because I'm going to ask you and this is a little bit off the topic, you're right about what you were

>> Sure. Absolutely.

saying. The more people don't recognize that I have a disability the more upset I'm going to become. But frustrated is one of those words that you have to attach a behavior to.

>> Uh-hmm.

>> So I don't know what frustrated is just like I don't know what inappropriate is.

>> Uh-hmm.

>> So I would say back to you if this student is frustrated, what are they doing?

>> Uh-hmm. Well, maybe aggression.

>> Okay. Well, what's aggression? What are they doing?

>> Okay. Maybe acting out, being mean to the other kids or being rude, saying things...

>> Okay. Saying that words.

>> Right, right.

>> Pushing at somebody else.

>> Throwing papers on the floor.

>> Uh-hmm.

>> Okay.

>> Tearing off the papers.

>> Yeah.

>> Okay. Right. So remember that when we used some of these words we're not communicating except to ourselves.

>> Right.

>> Because I don't know what inappropriate is and I don't know what frustrated is. We all used those words and we assume everybody else does, but I'm trying to push you to describe the behavior. Once

you describe the behavior then you need to go to the underlying process and say, what is it that I need to do to strengthen this child around these issues to make them more successful instead of

failure which is exactly what you were describing?"

>> Right.

>> Okay.

>> Excuse me. I think the other thing here is that a lot of times it's the externalizing kids who get the attention.

>> Right.

>> And there's a lot between two separates from the traumatic brain injury that are externalizing kids. They're internalizing kids and a lot of times they're not even coming up to anything sort of

attention because they're here--when they came here in this shift, there is [inaudible]

>> And that's our take for it. That's what we're talking about.

>> Right. And so they're not squeaking there in the classrooms.

>> A lot of times they just--they need to get along.

>> Right.

>> And I would worry then about depressions.

>> Exactly.

>> That is right.

>> No, and that's what we're talking about earlier today that that starts to happen. They feel it's normal for all of us, right?

>> Uh-hmm.

>> The more you lose, more loss that's in your life the more you're going to feel that you don't deserve some of this other...

>> Can I ask you a question?

>> Sure.

>> So--okay. I'm sorry.

>> I have to tell you. Well, we were--we were discussing too like it goes on the same line is that it's--what we were talking before about how you can set different rules and the classifications for

different students in your classroom. But we heard a lot of the times that compared to professionals in the classroom that don't understand that. They get really frustrated because there's just one

student who asks that all the time that hits, punches, screams kids, destroys classroom, tears stuff down on the walls. And then you have one student who never does that. And the one instance they do

they get in trouble but then another student takes four or five instances before they get the same consequence.

>> So it's hard to manage not only the students in the classroom but the other adults in that classroom as well.

>> Uh-hmm.

>> Exactly. I think that's--we're going to talk about a lot of that this afternoon. But the one thing that I did--what was I going to say to you? Oh, the one point that you're making which is

critical, who is not here today?

>> The classroom aids. Who are the ones that are with--oh, hallelujah. Good for you. Every school district should have the responsibility to get their aids here. They are the ones that are there six

>> Uh-hmm.

>> Classroom aids.

hours a day. They are the ones that need to know exactly what we're talking about because then you won't have that issue.

>> And because there's times during the day where like my lunch break where my students were at lunch or the specials throughout the day like music, art, gym and stuff like that that the cares are the

ones that are there with them. So they need to have the same training they needed so that they...

>> Exactly.

>> ...can handle situations, let's say, they needed.

>> Exactly.

>> I also feel professionals should be in the IEP meetings as well.

>> I agree.

>> [inaudible] have professionals.

>> And we have some parents in the audience and parents should hear that. And they should be asking for the peer professionals.

>> I'm also repeating it to the students on Brooklyn.

>> Good for you.

>> Well, that's how we're visioning here.

>> Very good. Brenda, did you want to say something about that?

>> Yeah, in Pennsylvania through the parent professional training that the Department of Ed was on, a few years ago we had a TBI training for peer professionals. It's three or three and a half hours

long, it's online and it's totally free. So if you're interested in that link, see me today and I will email it to you but it's really great for peer professionals from Pennsylvania.

>> Okay. Here's another resource for you.

>> Okay. As brain steps team leader off of the school districts when they would tell us that they have the student they will make us do the training and we specifically include the parent [inaudible]

>> That's wonderful. That's great.

>> So they totally handle things.

>> And do remember that when we started I said Pennsylvania has got an agenda and lots other states and you do because I've been in several other states recently and that is a new idea, so.

>> Could you walk me through because you're talking about on the slide [inaudible] behavior and I'm looking at the process and then we'll get to get intervention. So we just walk through that once--we

have a kid that's aggressive and let's say that they're pushing other kids.

>> Then we jumped through the process.

>> Okay.

>> Uh-hmm.

>> So we have to go back and I think that--I don't want still Beth Sunder for this afternoon.

>> Okay.

>> Because I'm--what I'm trying to do is set the concept that there is a disability, a behavior.

>> Uh-hmm.

>> And then things to do around that behavior. And if this morning, remember I'm like just take this away if you just...

>> ...understand that a kid who's rolling on the floor is--it's not that behavior, that's critical. It's what's going on, what precipitated. And she's going to talk a lot more about that this afternoon,

>> Okay.

>> Cool.

so I don't want to...

>> I'm not going to--I'm not going to jump in there.

>> Because she will.

>> Okay.

>> Great.

>> Okay. So I'm just going to take you through some of the processes and get the behaviors in your mind. Okay. So some inefficient processing of information. When you're a poor processor of

information it's because the rate, the amount or the complexity is too much for you. And so let me just ask--let me do this. You're not going to get out of here for lunch until you take a test. And

I'm going to give you the information that's going to be on the test right now. So you're going to need really pay attention right now and you're going to need really be clear about what I'm saying

because the door is locked and you're not getting out until you know this already, already. Here we go. I'm going to go back to the brain. I want to talk to you about the [inaudible] I want to talk

about the hippocampus. I want to talk about the parathyroid glands and all the other kinds of concepts that make us--I don't see anybody taking notes. So what would be wrong with what I just did?

>> You know, I'm not going to [inaudible] and the speed of what you're speaking is very rapid and it's almost like your words are just weren't the right together.

>> Okay. So my writing was too fast.

>> No lunch was my thing.

>> Okay.

>> Okay. So you didn't even--you didn't even get to what I was saying. She's overheard hungry. She's all--she's all upset. But guess what, she's at my classroom and that's absolutely something that

>> [indistinct chatter]

happens, right? Somebody back there had--you had your hand up.

>> Well, the one you just told us no lunch and we're totally locked. You put us into like a [inaudible] state you know, and...

>> Exactly. Exactly. It's--and it could be for me when I went to school that'd be any announcement of any test that was coming. Because, you know, I would be like studying for days because I was the

perfect student and I was, you know, scared to death. So I would do everything, tried to do it right. Okay. What else?

>> I know and I'm wondering the students have to get into my class, they have the lunch [inaudible] they needed to be like [inaudible] what is for lunch?

>> Uh-hmm.

>> We're going to lunch, it's almost time to go to lunch and then they're not paying attention to anything else you say.

>> Right.

>> Okay. So we never even got to, to what I was teaching you, right?

>> So--and so you have to...

>> So what I--so my writing was too fast.

>> Yeah.

>> Uh-hmm.

>> I started to use big words and she--somebody said, "You didn't do any pre-teaching. You didn't have any visual aids." So I started using vocabulary that you may or not have recognized. So, that

made it a little bit hard. And then I was giving you way too much information all at once. Wasn't I? And I wasn't helping you to localize where any of that information might be stored. So you weren't

associating or being able to categorize or connect to anything you already knew.

>> Also I would think a big one that's bolting would be that transition period. You were like, "Okay. We're going to be doing this now." And take a break and you want to [inaudible] wish me luck.

>> Exactly. That's it. They're not--they're not transitioned, okay.

>> We mentioned that was going to [inaudible] just something you already knew.

>> Okay. All right. So, that's what happened and that's the process, right? Rate complexity and amount. Now, you've all been in classroom too where that's happened. What behaviors are you going to

engage in? What are you going to do?

>> Tune out.

>> Tune out, okay. But see, I don't know how you're going to do that so tell me.

>> I'm probably just going to be sitting here thinking about lunch.

>> So you're just going to stare, you're going to be my daydreamer?

>> Daydreamer.

>> All right. Well, I'm not going too upset about you. I'm going to be a little irritated. Actually, I'm a little irritated that you're not paying attention to me but I don't have to punish you

because you're really not bothering anybody. What are you...

>> I'm going to run to make you get out quick before the door even locks.

>> Okay. So you're going to bolt the classroom. And guess what, as an adult you can do that. You can go, you know what...

>> [indistinct chatter]

>> All right. I'm not interested in everything that's really going on here anyway. And if I just pick up my purse and say go to the restroom then I'm going to take everything with me because I'm not

coming back. I'm going to go buy chocolate down at grocery, okay? So you can do that as an adult. What happens to the kid? That bolts a classroom.

>> [indistinct chatter]

>> They're in a ton of trouble. One of my favorite--one of my favorite workshops, this was years ago. We were--we were talking about this.

>> And, you know, so we were saying it's the underlying process. The kid is not punishing you by bolting the classroom. The kid is giving you a clear message, "I can't attend any longer, it's too

>> [indistinct chatter]

hard. It's too hard, I can't do it, I'm trying," so all of your behaviors, you know, talk to your friend. Try to get notes from somebody else. Now me, I'd be the one who hysterically trying to write

and look at my friend's paper because I wanted to get it--get it all right because I, you know, I wanted the A. I didn't want lunch, I wanted the A. Kind of weird person I am. All right. So I did

this little seminar and there were some teachers in the room and they said, "We have a kid like that. He just takes off, he runs all over the building. Now we have to figure a plan." Okay. So

they--one of them called--emailed me and said, "We've got the plan." So what they did--they have a speaker, you know, speaker system throughout the school and they came up with a code. And the code

was something like the pumpkins are orange. And that was the alert to every teacher in the building to go walk to the classroom door and look out in the hall to see if little Johnny was running down

the hall and then somebody would catch up. And take them to the office. Now I want to tell you if that was me, I'm thinking now the classroom as often as I could just to see who is going to catch me.

That's not the point.

>> And those kids all know that code.

>> Yeah.

>> Well, of course. You know, everybody--so that wasn't exactly what I had in mind. I was actually thinking about teacher modification of behavior on that one. So--okay. So this child also will have

difficulty processing abstract information. And by that, I don't mean anything all that hard. I mean double meaning of words, puns, humor. Oftentimes, our kids with brain injury do have a good sense

of humor when they use it. But when you use it back to them they do not get it because they're very literal and concrete and they become upset and disturbed that you are saying those things to them.

Or they don't see any humor because they don't understand double meanings of words anyway. Good therapy strategy to teach humor and double meanings of words and puns and what have you but just

because a child exhibits a sense of humor doesn't mean that they get it when you're trying to use it back to them. So we have to be careful with that. These kids do have difficulty learning new

information as we've already talked about that strategic learning. They don't learn a new game and they also don't generalize well. So, if I was on the computer and I learned one program today

putting me on the computer tomorrow with a different program doesn't mean that I can do it. And so there's a lot of relearning and reteaching that has to happen that sometimes we don't think about. I

had a little one second grader and he played soft--whatever. What do boys play baseball at that age?

>> [indistinct chatter]

>> But anyway, he played second base and speaking of not being able to learn the rules or you think you thought the rule. What he learned was that nobody should get by him on second base.

>> [indistinct chatter]

>> What he didn't learn was when you have the ball. So, anybody who would go and by second base he was taking out. So, how long did the parents tolerate that? I knew you've all been around parents a

little link players anyway. So, now we've got a whole social situation going here that kids shouldn't be on the ball team. What's wrong with that kid can't those parents teach him any respect for

other people, he's going to call my kid, he's going to break his leg, blah, blah, blah, blah. It turned out to be teach him the rule, that's how it was. Teach him the rule the way he should know the

rule and then he might be able to play baseball. He was physically fine to play baseball. He just missed that one little piece. So, let's make sure before we decide somebody cannot do something but

they actually cannot do it. There are little people, can two years old problem-solve?

>> [indistinct chatter]

>> Oh, yeah. Come on now. Have you seen him in the grocery store when they want candy? I have. See, as a parent you do the right thing, right? I will not tolerate this behavior. We will have to leave

the store. And as a grandparent I go, "Okay. You can have the candy." Well, the parents figure that out. I don't have to figure...

>> [inaudible] the aunt too?

>> What?

>> Have you not asked the aunt too?

>> I said, "Yeah, sure. Reinforce that bad behavior.

>> [inaudible] keep getting the one that...

>> See, there you go. Okay. And they may also only say there's one solution. So, if you go out today and you find there's a flat tire, how are you going to change--what are you going to do about that?

>> Call AAA.

>> Call AAA.

>> Change it.

>> Change it.

>> Find somebody to help you.

>> Find somebody to help you.

>> You should call AAA.

>> Another AAA.

>> Sit and cry until someone comes along and helps you. Yeah, okay. Which one of those solutions is correct?

>> Sit down and cry.

>> Yes.

>> All of them.

>> All of them. Oftentimes, a child will propose a solution that you might not have had in your head but if it's the one that works it's a good solution. So, what they really need to learn is, you

know, there's lots of ways to solve the problem too. All right. We've already took about the use of the word inappropriate I leave that there to remind me to say again. Please do not tell a child

their behavior is inappropriate. Tell them what their behavior is and why it's not acceptable to you at that point in time. Okay. All right. So, school is actually where social learning goes on. Are

there any questions about that? Because I'm hoping that I've set the stage for Beth a little bit this afternoon when she's now going to talk about those behaviors. But remember there's--I'm going to

give you some interventions this morning about some of the things for the underlying processes. She is going to give you the behavioral interventions. So, okay. School is also--and this is where

sometimes I get in trouble with teachers but academics are academics and there's another whole area of learning that goes on in the school, it's called social learning. That's who--you all became who

you are because of your social learning not because of math.

>> That's correct.

>> So, you learned by being in school. This is what bothers me about online learning, home schooling where the whole social interaction--this is actually an ad on the radio right now. I just--I want

to just look go crazy. My little Grace didn't have enough time to learn to dance. She loves to dance, so she's not going to go to public school anymore. We're going to put her online and then, you

know, she can dance whenever she wants. If that isn't the biggest bunch of malarkey that I've ever heard, apologies to anybody who home schools or charter schools or whatever else but social learning

is about half if not more of what happens in the school. And so this is a critical piece. It's especially critical for kids with traumatic brain injuries because that's one of the areas where they

will be the weakest. So, this is very, very important. So in school, these are our jobs, new learning, acquiring knowledge. Yes?

>> The social learning piece as well--I know the two of us are West Coast teachers, so the majority of our students are actually disabled. Some of them might have traumatic brain injury or other

health impairments, stuff like that as well. But the social skills piece I would say is huge and not just because of the fact that we're West Coast teachers but we also teach in our city. So we have

a lot of kids who are seeing behaviors that are not necessarily acceptable in school but it's because of what they're seeing in a community and at home and stuff like that. So, I know it needs--in my

building, this year my school psychologist would recommend once a week into the school [inaudible] little seminar activity with the students in my classroom because it is a big issue. And if they

don't have a social piece then how can they really perform.

>> And I would submit to you that you need to even go further because the social skills lesson that happens once a week has nothing to do with the social skills that should be going on every day.

>> Yeah. And we--because we do daily--we do daily stuff too like we transition and doing activities and stuff like that but they've never really had any formal social skills.

>> And I'm not saying you should be doing that.

>> I'm jut saying that...

>> And so--yeah.

>> Yeah.

>> ...sort of transition and to everything that you do...

>> ...has to go.

>> It has to naturally...

>> It has to naturally happen every day.

>> Yes, exactly.

>> But having that extra like 30-minute dedication specifically to that instead of working it in throughout the whole day it gives them that link to--this is what we learned about and now Ms. Parker

is going to incorporate what we learn this week and with the rest of the week with all the other activities.

>> Great. That's good. Okay. So our social--our job at school is that new learning. It's also practicing and--as, you know, rehearsal repetition is good so we have to practice and completely learn

knowledge. We have to have mental and cognitive exertion, essential to new learning. And guess what, that's where our child gets fatigue, right? And that's where we have problems for that practice

piece for our kids with brain injury. And remember again speech pathology coming out but language capacity, your ability to have vocabulary to understand what's being said to you and be able to

express yourself somehow doesn't always have to be verbally but be able to get your information back out is absolutely critical to social learning. There's no way that I can be social without a give

and take relationship between me and somebody else. That's communication and it's absolutely key to what has to happen. As you know executive functioning is a part of what we talk about when we talk

about kids with traumatic brain injury. And so there are three parts of executive functioning development pieces that have to happen which are critical for every kid but oftentimes don't happen for

our kids with traumatic brain injury. So, they have to have this control of self structure, their work, their school, their free time. They have to know that they must delay their gratification

sometimes and they have to be able to initiate complex behaviors with minimal queues. That's what the work environment is. That's the work environment. I had a young gal. She was at McDonald's. And

McDonald's, by the way, is one of the better employers of individuals with disability. So, you know, hats off to McDonald's for that. But we had the manager call and say she can't stay here. Okay.

Why? "She can't do her job." All right. Can I come and watch? That's always what you say. You don't ever go, "Oh, okay, we'll take them back. This isn't a good location for them." But you say, "Let

me come and watch and see what's going on." Well, she was at the French fryer and she was the most phenomenal French fryer ever. The French fries were hot, they were salted, they were in the boxes,

everything was fine. But the manager would walk by and he would say, "Go in the cooler and get the chicken patties, take them over to the--whoever, Jeff, who's frying chicken patties. So she would

start, go to the manager, "What do you want me to do?" He'll repeat again. She'll get to the cooler, back to the manager, "I'm at the cooler but what was I supposed to get?" Okay. You're the manager,

what are you saying by now? "Give me a break. She cannot do the job. Get her out of here. This is a person with a brain injury. I don't even know why I hired them." All right. Solve the problem.

>> [inaudible]

>> She couldn't--she couldn't do minimal--she couldn't get it with minimal queues, right?

>> Right information.

>> All right. So either don't give her other jobs to do, that'd be one, or if you're going to...

>> She's successful with the French fries so.

>> ...leave her alone there or if you want her occasionally in the kitchen and do something else, what did you say?

>> Pictures, word lists. What do you want to do in the cooler? Because then of course she couldn't find chicken patties in the cooler, what are you going to do in the cooler?

>> Make sure there's a right picture.

>> Make sure the chicken patties are labeled.

>> Label the cooler for crying out loud, and who does that help?

>> Everybody.

>> Absolutely everybody. So, you know, just because that's a complex behavior and she was only getting minimal queues and they weren't sufficient for her. So--but in normal development of executive

functioning you have to be able to do that with minimal queues. So either we get the person along or we put structures under the person. Okay. We also have to do this abstraction and we've talked

about that already. And then there's this time piece in executive functioning so that your plan, your sequence, you know how much time you need, et cetera, et cetera. So, those are the things that we

all have to develop and we know after a brain injury those pieces are oftentimes missing. So our social development because we don't have that executive functioning piece, we don't have the strategic

learning piece becomes a problem for us. So, this is some information about just normal adolescents. This is what our normal adolescent should be able to do. They should be able to elaborate and

abstract their self knowledge. They have to have sophistication and some other executive functioning. They have to be able to separate from family and engage with their peers and they have to have

sophisticated interaction system. In other words, I can't walk over here because guess what I just did. I have just violated your space but I will need your attention because I have a brain injury

and I want you to answer my question. So, this type of behavior in an adolescent especially an adolescent male is very unacceptable to her. She's not sitting there going, oh, perhaps he hasn't

evolved his social interaction skills. He doesn't know anything about give and take, doesn't know anything about space. And by the way, females will tolerate two to four feet; males want three to six

feet. So, there's a whole different pattern going on there even. So, all right. But this is normal. This is what you should be able to do and this gets you your identity formation. This is who you

become and this is how you have a sense of belonging. This is how you got your friends. This is how you got your activities that you participated in, in high school and what you have maintained

today. They may have changed over time but the same procedure that you use in junior high and high school to decide how am I going to be social. How am I going to interact socially is guiding you

now. That's normal. After a brain injury, they're concrete thinkers. That's exact opposite. They have impairments in their self-regulation and their metacognition which is--which is their general

overall gist in problem solving. Separation from peers, they are separated at the time when we all wanted to be with our friends. When we were practicing dating and relationships and all those

skills, these kids are isolated. They have increase supervision by their families instead of a decrease. And if I were a parent that have increase supervision for me too, so there's a disconnect

there for them. And they have these impairments in their communication skills, which is going to make them less social. So, what we have here is an effect on their identification, their identify

formation which again has to do with the social interaction or the social intelligence as now everybody in the world is starting to research social intelligence. I keep looking at Beth because she is

a speech pathologist too and there are couple other speech pathologists. You know, we study that for a hundred years, now it's a whole new field of research. So just so you know we did it first. So,

what about those developments related to communication? So, here's what we know. They--oftentimes, we'll have delay in their semantics and that has to do with their vocabulary, lousy vocabulary.

Okay. So, that tells you what to do in therapy. They're really--their grammatical structure is usually okay. They don't usually have big grammar problems that we need to deal with. But pragmatics,

the phenotypes are involved and it's proportional to how much of the cognitive problems they have. So, when some research has been done on this, they get lower scores in their peer result. Any test

of emotion, they don't recognize emotion, they don't recognize anything from eyes, faces, videos, what have you. And Willers recent work is on -- that he just published in '13, 30% of -- 30% of all

the students they tested had serious difficulty with facial or emotional recognition. And so this is the work by Turkstra and me and a few others and this is the picture that we used. And facial

features should be universally able to be interpreted. It's not cultural. We all interpret facial reactions pretty much the same. So, what do you think is going on here? How about the gal back here?

>> She's upset about something.

>> She upset about something. Something isn't going right for her, right?

>> [inaudible] yeah.

>> [inaudible] too close to the other girl.

>> How about the girl in the pink?

>> She's, like, uh-huh.

>> Uh-huh, it's work -- it's working for me. It's working for me.

>> It's working for me.

>> [inaudible] looks like he's holding her.

>> He's holding her hand. How about him?

>> He's, like, uh-oh, I'm in trouble.

>> I'm in a little trouble here. I don't know exactly who to look at or what to do. All right. That didn't take you very long, right?

>> [indistinct chatter]

>> This is probably the old girlfriend, this is probably the new girlfriend, and she just found out that there's a new girlfriend here and he's in trouble. All right. We all recognize that and you all

described that pretty carefully and pretty quickly, right? When we did our study, about 75% of the kids with brain injury had no idea. They could not describe any emotion. They couldn't figure it

out. They thought she was the teacher. She was mad at these two students. One was a good student, one was a bad student, I mean, there were amazing interpretations that had nothing to do with the

facial -- the facial expressions on their faces. So, it's very critical that we understand this is the concept, the social interaction. This is our kids who do not know that they're too -- that they

are in your space, who do not recognize anger on your face. They don't recognize it. So, there's a lot of work to be done along these particular pragmatic interactions to make this kid successful and

so that becomes really, really important. Oh, I just went back instead of forward. No, wait. Okay. So, when we're worried about these peers, and we have to worry about peers, we all have friends. We

know from 35 years that the one thing that is standard is that our kids start to lose their friends. Their circle of friend becomes smaller and family starts filling in for social activities. So, we

have to know that this happens. It's very, very complex and is there something we could do about that. And here's something that's interesting, the peers will say that's fine, you know, I'll be their

friend, but in actuality, they don't. Ann Glang did a study years back in the schools of Oregon and they actually had peer mentors and this was an incredibly successful program. They matched a kid

with a kid with a brain injury and they were their friends in school and they got them to classes and they got their homework done and they got everything done except when the bell rang, that was it.

There was no invitation to go to the movie, let -- no request let's go watch a basketball game, nothing on the weekends, nothing, nothing. So, you can't create friends. You have to make your friends.

But what is it that we're missing for our kids that we are not teaching or supporting to happen? And so that's why the social intelligence is starting to become such a big deal and why teaching our

kids to recognize facial expressions, teaching them appropriate social interactions, teaching them what's in your head, you know, you have to try and filter a little bit. We know that's your

disability but think about, you know, procedural learning, which is a lot of what Turkstra talks about, is she gets her kids learning procedural activities. "Hello, how are you? I am fine." And then

the next thing that the kid with the brain injury has to say is something about you. I like your orange shirt. Did you watch a movie last night? Did you watch the basketball game last night? They're

not allowed to talk about themselves. They have to learn and they learn it procedurally because they have to do it every time they initiate a conversation. So, procedural learning becomes very

critical to what our kids need to learn and that's part of our Social Skills Training. Okay. The other thing is this last point here and I got to watch my time. This high susceptibility to peer

influence, we already know that teenagers especially teenage males are more susceptible to peer influence as a study on driving that was done where they put adolescents, young adults, and older

adults in a car and it was -- it was a fake car, you know, and so you're going down this highway and you have 30 chances to either stop at the red light or the stop sign or to make a decision that

you can go through it. Obviously, if it's a stop sign, you have to stop. But if it was a yellow light, sometimes you actually had time to go through it and sometimes you didn't, you should've

stopped. And so you can guess what the research showed. It showed that adolescent males were the most -- females were okay. They didn't do much worse with the peer in the car. They -- so they did it

by themselves and then they put a peer beside them in the car. That condition was worse for everybody including all of us as adults. If you have somebody in the car, you're more likely to run a red

light. But teenage males were absolutely skyrocketed. When they had a buddy in the car, they were going through the red light. There was no question about it. So we know that normals, whatever that

is, are susceptible to peer influence. We all are. But after traumatic brain injury, remember, you're already socially impaired and you want your friends, so you're going to do -- I mean, you know,

you see it every -- on TV a lot, you know. Some kid gets -- there's a story, I can't even remember what it was, but he was convinced by the gang to get up and shoot the mayor. Blue Bloods, that's

where it happened. So, he got up and shot the mayor because he wanted his friends to like him and they got him to actually do that. So, we know that people with disabilities are more susceptible to

that kind of influence and a lot of that is so we can laugh at them after they do whatever they were convinced to do. So again, just in summary of this social stuff, the frontal lobe functions are

vulnerable. The injury before adolescence may significantly delay what they're doing. Adolescence though perceives social and emotional cues accurately. Most of them however will tell you they're

typical. They don't perceive that they don't have friends. I mean, they know they don't have friends but they don't see themselves as any different than any other teenager. And there's a negative in

consequence of -- by losing your friends, as there is for all of us, all of us. None of us like to have no friends. Some of us are happy with one or two, some of us need five hundred, but we still

want to have somebody to be involved in our lives. Intervention, Chapman is doing a lot of work on this as is Turkstra, Turkstra more with the adult population, Chapman more with the kids. What

they're saying is you have to intervene before developmentally it becomes a problem. So if you know adolescents, young adolescents, 13-year-olds and 14-year-olds are going to be practicing and

learning social interactions and, you know, that's how to be a friend for more than a day, you know, how to date, how to have relationships, et cetera, et cetera. If you know that that's going to

start with all your kids when they're twelve years old and they're getting younger all the time then she says then you start this intervention, these social interventions when they're ten or when

they're nine or whenever you find that there's a need for them to start understanding and learning these behaviors and learning some of these social skills. And they -- this has to happen before you

lose your friends. Once you become identified as the weirdo in the classroom, you're not going to take two lessons on social skills and all of a sudden be socially acceptable and have lots of

friends, not going to happen, because you've already failed which is what we talked about earlier. Once you failed, it's 10 times harder than if you've been given the skills before you failed. So

that's, you know, very, very critical. I am going to go to daily service for a while now. So some things that -- if you didn't learn anything else today in daily service, this is what you do

everyday. And so what are some of the interventions or some of the pieces of information that we need to know? First of all, concussions happen to all kids and learning can be affected. We're going

to spend about two minutes on concussions in a -- in a couple of minutes because there's plenty of information about that right now. But the one piece that does bother me about that is it's all of a

sudden related to sports. Guess what, kids fall out of trees, they fall on the playground, they get hit by their parents, there are a lot of kids that suffer concussions that never put their foot on

an athletic field and the symptoms are the same and the treatment is the same. So, while the message is getting out, it's not the complete message. And that's the piece that I would like you to take

with you today. Strategies that might help are available. We're going to -- I'm going to give you some of those and I -- you know, you got books of those. And then there are -- there really are

promising practices and resources out there that do exist. Let's not reinvent the wheel. There are lots of materials. There are lots of resources that we can find on the web, from a lot of different

places. So, it's not like we have to go and write the manual. The manuals had been written for years. What's important is the manuals that exist have to be in the right hands and you all are the

right hands. So, you're the ones that need to know where these materials are so you can help disseminate them to the people that need to use them on a daily basis. So, let's do my tribute to

concussion here. I know -- first of all, you need to know that every state in the union now has some sort of a concussion law and that is -- I will give the NFL credit. I was at the meeting where the

NFL actually committed and that was three years ago that they would work in every state until every state had some sort of legislation around concussion. And they have done that. And they have

actually recognized now that little people get concussions. The piece that is not particularly well-recognized is that in those 10% of kids who continue to have symptoms after concussion, there's

learning problems there. There's educational problems there. That piece is not one that some of our athletic organizations really want to publicize a whole lot. So -- but I'm telling you that we know

that that does happen. So, regardless of the state and how the law is written, almost every law is only involved with, like, the first four weeks after the concussion and very few states mandate

anything beyond that. So, what is mandated in every state is the athlete has to be informed about what a concussion is. They have to know the symptoms and they have to sign a paper that says that

they'd been educated and that they know. And it's implied that they should report to their coach if they have that injury. Parents also, if their child is going to be involved in athletics, have to

be trained. They also have to sign off. And the coaches have to be trained and actually they have to have that annually and they usually have to have some sort of a certificate that proves that they

actually did take the training. So, that's pretty much in every state. Now, who can return people to play and how they get returned to play is very different in every state. But we will give credit

where credit is due. At least every state has now a recognition that students have problems and that they -- that they need to be followed. Now, after the four weeks, the law sort of went away for

almost every state so that 10% of kids who continues to have headaches, continues to have attention problems, continues to not do well in school, continues to have behavior problem, continues to be

fatigued, has visual problems or auditory problems that they can't tolerate, a lot of light or a lot of noise or what have you, there's nobody saying much about those kids or what should happen. Now,

in Pennsylvania, what should happen? There should be a brainstems referral, absolute brainstem. I don't think that's right. There should be a brainstem referral. No, tri-step, yeah. I did not say go

to a neurologist to have a brainstem evaluation. Go to -- but that's what should happen. That should be it -- in this state, that should be really easy. So, you know, get your school districts to

enact that part of the law. It's not a law but it can be a regulation for how you're going to handle your kids in your school district. It shouldn't be that difficult. And it is. Okay. So certainly,

there are some things that we all have to worry about and that's how much rest after concussion. Now, we can go -- and this is where we start getting in trouble with brain injury and this is why way

back early, I said, "You know what, there's so many different ideas out there. I'm not sure how we get information across because everybody has something different." Rest after concussion is one of

those things. You can go from somebody who says you have to be in a dark room for five days and do nothing to somebody who says twenty-four hours and then add activities as you can tolerate them to

somebody who says, "Oh, just go back if you're alert and what have you, you'll be fine." So that -- and to be honest with you, there's not a whole lot of research out there to back up any of those

ideas. So, I mean, common sense would tell you that trying to keep a kid in the dark -- try keep any of us in the dark room for five days, no TV, no radio, no nothing for five -- don't be ridiculous.

Can't be done. Unless you're going to put me in a coma. So, you know, think about what's reasonable, that's probably the best thing to happen. One of the things that we do have is challenges in the

classroom after concussion. So, we do have to be aware of that. We do have to manage our kids. There are some concussion standards and guidelines that have come out very recently. Certainly, the CDC,

and these are active links that you can go on and take a look at, the first one is the CDC. As you all know, there's a ton of kits, there's a ton of videos, there's training materials, the coaches

training is right there, the certificate prints off, there's a -- just hundreds of things on that site. The second one I just participated in and this is the guidelines from Ontario. And Ontario has

put out for rehabilitation very specific guidelines for pediatrics. So, if you're interested in looking at about a hundred-page document -- but it has a lot of, like, little checklists and things

that are very good. And then Siebert, which is the teaching research group out in Oregon, also have resources for educators and it is an outstanding source. So, I encourage you to go ahead and go on

all three of these and find information. And you're writing it down, aren't you? Are you, people? It'll be on -- it's in the handout. Okay. All right. So, let's talk as time remains here about some

interventions. I'm going to talk about a couple of these because these are my little soapboxes I like to get up on. One is attention. I am convinced that you cannot teach a child if they're not

attending. So, there are two things that I think need to be in IEPs or 504s or RTIs or anything else, and that is, first of all, have you done an adequate task analysis to determine what you're

asking this child to do? Because my guess is we give too complicated of a job to our kids all the time. You know, we all get into routines. Remember that categorization and association, there's about

a hundred worksheets, right? Up is to, boy is to, in is to, and we all -- okay. This is a good activity. We certainly don't go and it's creating neuronal tracts in the brain, kids like to do it, I'm

going to pull this worksheet out and we're going to do it today. All right. But did you analyze what you're asking them to do? Are you analyzing homework? Which I don't advocate for kids with brain

injury by the way. But if you're sending homework home, it should be something that they can do a hundred percent correct. It's just rehearsal. And you should analyze the task because, guess what,

when I have a worksheet sent home, the first thing I have to do is A, remember that I have it, B, get my materials, a pencil, the paper, whatever it is that I need that's part of my task analysis, C,

read the directions or know the directions, know that I start at the top of the page and go to the bottom of the page and determine how many of those I have to answer because in some cases my

attention is going out before I finish the homework assignment. And if that's the case then I should know that I only have to do half or I have to do three-quarters or I have to do two or whatever it

is. That's a careful task analysis. How many steps to baking a cake?

>> [indistinct chatter]

>> Does it take you any time at all to figure out how to bake a cake? Because you've done it, it's automatic. That's how some of your assignments are, too. You've used these assignments for so many

years that you don't analyze the task anymore. You don't know how complicated some of the jobs are that you're asking kids with brain injury to do. So, analyze your task, figure out how many steps

are there and then provide a way for this child to be successful. And by that, I mean if there are sixteen steps to a task, maybe they can do four sets of four but they can't do sixteen. So,

providing the structure whereby they can be successful, and that's not new news to any of you but it is kind of new news because when you send that assignment home or when you -- when you're having

an activity, you're not thinking along those lines for the success of the child. I'm just reminding that. The other thing that I think is critical is task completion. You should never have a child

not finish their job. I see IEPs that say child will attend for three minutes, child will attend for five minutes, and I say that's not a good IP because I'm suggesting to you that nobody attends

like that. You're not sitting here today going, "Well, I'm going attend for five minutes. Then I'll take a little break and then I'll go for seven." You attend until you're done. So it -- that is

critical for our kids with brain injury because success is critical. And so they can't be sent home with the homework, finish it. I mean, what happens to you on a day when you start one job, you got

interrupted, you got sent for a second job, and you get interrupted on that, and the third thing you started to do you got about half done and then you had to go back to the first job and -- so your

day goes, right? And at the end of the day, how are you feeling? Exhausted. That's exactly right. And you're also -- so what do you do? Do you pack up your work and take it home? Some of you do and

some of you go, "It'll be here tomorrow," and you leave. But what did you do to the kid with the brain injury? You packed it up in homework and you sent it home. And then you said to an exhausted kid

because you just said you were exhausted, you just said to an exhausted kid, "How about if you spend another hour with your parent trying to push you into getting this work done that you were

struggling with in school today?" And then we're amazed at the outburst that parents talk about. We created it. My favorite example, I had a kid. Well, this is a bad teaching technique to begin with

for anybody but this was a math teacher who sent 10 problems home. That's so far, so good. But if you missed one, you got 10 more. Well, guess what if you missed nine? I had a kid with a brain injury

go home with 280 problems. He broke his sister's arm that night. And what did we -- what do you suppose the conclusion was by the team?

>> [indistinct chatter]

>> This kid is out of control. This kid is out of control. We don't even know if he should be in the school. No, the teacher is out of control. The teacher is out of control. That's a terrible

assignment especially for a kid who's not -- I mean, I would've been doing thousands of math problems. So, task completion, modify the task so that they can finish it. Let me give you a very specific

example. Do not write, just write in your IEP to task completion, child will learn vocabulary with assistance to task completion. All right. And that means if you learn two today, that's good. I can

ask you to make your bed. And my -- I can require you to get the pillow and the bed spread on there. Good job, two steps, wonderful. I'm going to make it a little longer tomorrow because that's going

to lengthen your time, right? Bed spread, pillow, and sheet. Good job. Tomorrow, bed spread, sheets, blanket, pillow. I can make that into a whole -- instead of a one-minute task, I can make it a

five-minute task. But I can make you succeed at every step along the line by adding one step at a time. That's what task completion is. Same thing with math papers or, you know, those homework

assignments that I keep talking about. There's time that you have in the classroom. Only answer the first two questions. Now, somebody will say, "Well, but the kid wants to do the same as everybody

else." Fine. Answer all ten but I'm only grading the first two. And when I'm sure that you've got the first two then I'll grade three, and then I'll grade four, et cetera, et cetera. So, task

completion belongs as far as I'm concerned on just about every intervention plan. Now, what is listed here, and I'm not going to go through these because this is nothing more than you already know,

this has come from teachers and teachers have the best strategies. Once they know there's an attention issue, they know the strategies to use. And if you don't, well, then these are reported

anecdotally from teachers over the last 25 years. So, here are things that work. And cue words and a non-verbal cueing system works really very well and you all know this because you're teachers and

you very well know that right now there's no way she isn't looking at me. Right? Because why?

>> [indistinct chatter]

>> Because I got proximity, exactly. So -- but if my -- if she had a brain injury, I would never do that without a private conversation with her that says sometimes you don't pay attention. So, what

do you think I could do? And if they can't think of something -- because sometimes a kid will solve it and if they -- if they solve it, that's what they want you to do. And that would be more

successful because they thought of it instead of you. So, you know, if it's reasonable and they suggest that that's cool, otherwise this is the one that I like the best so I might say, "Would you

mind if I just walked over? And I won't touch you but I'll touch the desk." And I don't even have to look at her because I already know she's looking back at me. So, those non-verbal cueing systems

-- but the student has to know what you're doing. It's not a big surprise, it's not, you know, out of the blue that you're going to do that for that particular student. This is John. And John

sustained a traumatic brain injury. He was in -- he was in two car crashes, severely injured, and became a stutterer after his injury. But developmentally, he was very bright. And so they thought he

was gifted in kindergarten. He was in a car crash between first -- kindergarten and first grade. And now, he's in fourth grade and it's the first time he's starting to exhibit reading problems. He's

starting to not get along with his peers. A lot of things are starting to happen so that's why we met John. But John was very smart and he actually wrote his own IP. And so here's what he had to say

about attention.

>> [inaudible] I'm getting [inaudible] going on right around me that make [inaudible] wonder that I get [inaudible] like...

>> So, simply stated in the IEP, get him in a simpler environment where there isn't so much stuff going on. Memory interventions, internal and external aids. Internal are the techniques like

mnemonics, all those sorts of things. Internal techniques are not particularly successful with kids with brain injury. You can rehearse them until the [inaudible] come home. You're not going to get

better at rehearsal. Mnemonics are way too cognitively challenging. I never could figure them out actually sometimes so -- but our external aids, I'll talk a little bit later about external aids, but

they really are useful, certainly technology comes in here and I very briefly want to go over that before we finish. So -- and this is John over time constraints.

>> What do you think people can do to help you out in school?

>> [inaudible]

>> So, you want more time to finish your work?

>> Yeah.

>> And if I had time, I would take you through all his comments and you would have the IEP when we were finished because he's telling you exactly what needs to happen in his environment for him to be

successful. These are internal strategies that teachers tell us have worked. I left rehearsal on there, again, simply to say to you remember that that is rote learning and all that strategic learning

that we talked about earlier. Procedural rehearsal is good. Rehearsal of rote information does not work with these kids. And we already know it doesn't work with most of us. So, do not sit down a kid

and have them practice list of things like 279, you know, we used to have numbers and word lists of unrelated words to repeat back. The research on that shows that if you do that, somebody could

repeat four if you do it for a year, which I would be insane. They would have me diagnosed by then if I was doing that for a year. You can do five. So, what's the point of some of those irrelevant

activities? External -- pre-teaching vocabulary is huge for these kids. If I'm going to learn about the heart tomorrow with my teacher, I should learn the vocabulary about it today. Tomorrow you're

going to talk about the heart. The heart has four chambers. This is what they're called. You're going to hear about it tomorrow in class. So, pre-teaching vocabulary -- and I will talk to you about

some of the technology. Organizational strategies. I'm not -- I'm not going to go through all these because, once again, these are -- you're going to get them on your handout and these are things

that you already know to do. They're already in many of the manuals that you've had. The bottom one, the person -- this is Mark Ylvisaker's suggestion and it really is a good one to start a kid out

with a coach. Five minutes, and this is oftentimes another student. Five minutes in the morning, five minutes at the end of the day. Today, we have whatever, the assembly in the auditorium. Today,

you have a test in Math. What's two plus two? Five minutes of setting them up for the structure for the day and five minutes at the end of the day. You're going home. Is there something you have to

take with you? Where's your notebook? Or whatever it is. Very, very successful with a lot of our kids. Certainly, sorting, putting things in a bag like jewelry and makeup and whatever and then having

people sort and organize and classify, very important for organization. For strategic learning, this is critical. Kids need to learn the main idea and two supporting pieces of information. They can

-- if they're verbal, they can say it to you, you know, "You get the assignment. George Washington crossed the Delaware. Who crossed the Delaware? When? Where?" You know, those types of things. They

need to know that. Highlight the main ideas if they're -- if they're -- if they are readers. You know, sometimes, I'll see on an IEP use a high -- try to -- child will lose out. Use a highlighter.

Why is that not something that belongs on the IEP? At best -- go ahead.

>> It doesn't say what for.

>> Yeah, not only that, but at best, that's a material because if I just say, "Here you go. Here's a highlighter. Highlight everything that you think is important on this page," what's happening?

>> [indistinct chatter]

>> The entire thing is yellow or orange or whatever color. But the IEP should say child will learn to identify two main ideas and two supporting pieces of information. Highlighter will be used to find

-- to mark the -- you know, it's a material. It's not a goal on an IEP to use a highlighter. And then, you know, if the child is not verbal, using demonstration, technology, pictures, whatever to

make sure they get that. If they're going to do problem solving, the child needs to tell you, "How did I do it?" And, "How did I do it right?" Most of the time when I get a paper back, when I was in

school, it was marked wrong. Could you please start giving kids' papers back with what they did right and happy faces? And then discuss with them, "How did you solve the problem? Because if you got

it right, who always means a person. Tomorrow, it'll be another question and it'll say who. And when it says who, you're going to give me a name just like you did today. Good job." Okay. So, that's

what they need to do. How did you do it and what was right about what you did? I took a big number four. I took a little number away from it because I'm subtracting. When I subtract, in most cases,

because I'm not going to talk about negative numbers with a kid with a brain injury or even me, so, all right, I have a big number, I took a little number away, I got a little number. That's the

process by which you do subtraction. If this kid understands that and tells you how they solved the problem, it's more important than if they got the actual match correct because guess what, the

calculator will get it right. They just need to know that they got a smaller number, okay? So, how did I get it right? We've talked about language. I'm not going to go into that. Interventions with

little kids, they need to play. They need to have social interactions with other children and other families. Sometimes, parents will say, "What can I do?" I say take the kid next door and go get ice

cream. Eat the ice cream, let them pay for the ice cream, and take him back home. That's about enough for a preschooler who needs social interaction training. But do it consciously. Do these things

consciously and planned. Stimulate their receptive and expressive vocabulary. These kids are going to be poor in their vocabulary. They need a lot of vocabulary pushing and they need to start

vocational transitions. And that's what you do at work. You take turns. So, you need to teach turn-taking, clearly planned turn-taking, and responsibility, like, "Now, we're putting our toys away,"

or, "We're going to organize our toys because all the trucks are going on this shelf," whatever it is to start getting executive functioning, social interaction, and some of these other things going

needs to get started. Technology is the key factor I believe in some of the interprofessional work. Now, it's almost impossible to keep up and I see there are lots of AAC sessions and interactive

technology sessions and that's always wonderful. Let me tell you that I had a federal grant for six years and some of the instrumentation is actually too complex for our kids with brain injury, but

the simpler technology is phenomenal. It's their memory. It's their organization. It's their planning. And what we found is an unintended consequence. It's also their social success because our kids

were wearing either cell phones or at the time we started to study, there were PalmPilots and Dells and those types of PDAs available and that's all that was available. There wasn't such a thing as

an iPad. But you got to be careful because iPads are complicated. I don't know about you, but every time a new one comes out or a new cell phone comes out, I want to just kill myself because I can't

ever figure it out. So, if we have difficulty with that, our kids are going to have difficulty with that. The more generic, the better because if I use a generic device, I'm like everybody else. If

I'm walking around with a huge screen with all this other stuff that's been programmed for me, I may as well be back with the pilgrims with that A on my forehead that says, "Look at me. I have major

problems and I can't function like everybody else." If I pull out my cell phone -- you all did. You all left on break and pulled out your cell phones. So, we're just using normalcy for our kids which

is very good. Certainly, distance and online information and then all the simulations, the avatars, the standardized patients, the technological created patients, all these things is helping us

become better to deal with our kids. So, why would we care about my research on Wednesday morning especially right before lunch? Well, if you want to get funded for some of the generic devices, you

got problems with insurance companies and school districts and everything else when you go and say, "You know, there's an iPad on eBay for 25 bucks and I need to get this or a PDA or whatever else

because Johnny needs it for memory and organization." The answer is they're going to use it for social activities and that's -- but guess what, that should be on your IEP anyway for these kids. Oh,

they're going to use it for social activities, right. That's goal number two. So, they're going to use that iPad. They're going to use that whatever to learn to play and turn-take with their

neighbor. So, yeah, you're right. They are going to use it for social interaction which is the second thing they do badly besides memory and organization. So, it all becomes on how you qualify for

these services, but there is a body of research. I have five articles published. There are newer articles out now where people are absolutely supporting for people -- kids with brain injuries that

technology is the way to go to help support some of the skills that they'll never have. It's just, like, when do you use a calculator with kids with brain injury to do their math? Some teachers would

say never. And you would say day one, and I would agree with you, the day that you show me that you understand that subtraction means four minus two is a littler number is the day I hand you the

calculator to get the right numbers because I don't care about the numbers. I care about the procedure. I care about if you went to McDonald's and you gave him a $20 bill that you know that you

should get about $10 back. That's what I do now. I never count my change. I'm not a mathematician. I figure, "Okay. So, it should be about 10. I'll take 10." I probably get ripped off all the time. I

don't know. But it can justify best practice and that's what you need in your plans if you want to get these provisions for these kids. This is Shelby and this is just the grad -- one of the grad

students teaching her on her device.

>> [inaudible]

>> Can you hear that? Sir, it's real low.

>> [inaudible]

>> [inaudible]

>> Okay. We can't hear that one. But anyway, what she's doing is she's learning to put contacts list in. And so she wanted to put her mom in. And so she's, "Well, what does your mom's name start

with?" She said, "M." And she says, "No, it -- your mom's name doesn't start with M." She goes, "Yeah, I call her mom." So...

>> [indistinct chatter]

>> So, the questions are, does this electronic organizer help the reorganization of the brain? It -- and what we're showing is yes, concerns with memory after brain injury, and can these devices

stimulate different pathways development? And the answer to that is starting to be yes as well. When they look at kids on spec scans, they're actually developing different neuronal pathways with the

support of the device. So, to me, it's just like that brace on the leg. It's -- there's no difference to me in using some of these devices. So, I'm going to share with you some of the things that we

found out. So, the -- what we found, and we had four different conditions, one was just a list on a piece of paper and that was one condition. Another condition was a day planner. It's in my

textbook. It's in everybody's book, that they ever read about it, give the kid a day planner and make them use a day planner. And then there were two electronic devices because we would -- we didn't

want to say it's the PalmPilot study or it's a Nokia study. So, we had different devices, electronic devices, and two of the four conditions. And what we found was that the electronic reminders were

the key. These kids were much better at being independent because they heard the beep or they felt the vibration if they were in school. They wore them around their neck. One of the big concerns of

parents was they will lose them. Not one kid lost their device. It was sort of like your purse or your wallet. It became so important to them. They were socially accepted for these devices and they

were successful with these devices. So, it was important to them. They did not lose them. We had two stolen and they were -- they were stolen by other kids who wanted the devices, you know. It wasn't

like they're getting assaulted on the street for them. It was other -- in fact, we had one little girl who advocated. She went to her teacher and she goes, "All kids should have cell phones because

we learn better in school with cell phones." So, there was the beep or the vibration.

>> Did you let that kid get a phone?

>> So, like, homework?

>> Yes.

>> We did. And when the study was over, they got to keep them. So -- okay.

>> Like, in my -- in my districts, it would be great to let them take them home so if they have their homework in it, then we never see them back.

>> Well, I mean, I -- we did meet with parents and we did get obligations from the parents and the kids. And I do think that because of the population that we studied, there was a commitment on the

part of the parents to make sure that they did come back. But the kids charge them themselves. They never worry even -- they never even came back with bad batteries. They all charge them. So, we did

have some who -- we had two who chose not to keep the devices and they chose $50 instead. And actually, those were impoverished families. And we weren't ever sure what the reason was that they --

that they made that decision but -- okay. And we did believe that even though some of the kids never learned to program the devices, they learned to respond to the device. So, it didn't matter if the

teacher or the aid or the parent was programming the device. When the beeper went off, the kid learned to respond which meant nobody was nagging at them. And that's what they said on the interview.

"Nobody was nagging me to go take my pills or to go see the speech therapist or go and do anything. I looked at it, it told me what to do. I went and did it." And then in some instances, we had

second graders and they had pictures. So, it wasn't that it always had to be typed in there for them to see what was important. Now, also very interesting, the PDAs and the cell phones were the most

successful. It was the beep that helped or the vibration. The least successful condition was the organizer. The paper organizer that we all hand out now to all the kids and whatever, seventh grade,

they learned to use an organizer. Well, guess what? And I will tell you that I've had people telling me that some school districts now are requiring kids to use the organizer and they get bad grades

if they come back and they haven't filled it in. What kind of sense does that make? If it doesn't become important to you to use it, you're not going to use it. And if you punish me because I didn't

use it, it doesn't even make any sense. Okay. So, anyway, now, you have research that says that's the worst condition. They were better off with a list on their desk that said, "Today, when -- at

2:00, go ask your teacher for her assignment." And one of their assignments was they had to call in to us. And they had 15 minutes so that we could have -- I had a time stamp to know that they got

the message and they actually responded. So, you know, we have a lot of data that shows that these kids really did do well. They were given -- for the first set of conditions, they were given a

verbal reminder in the morning. Remember, some time today, you'll have something to do. The second time that we went through it, they weren't given a verbal reminder. Being given one verbal reminder

in the morning made them about a hundred percent more successful with doing all their jobs all day long. So, back to Ylvisaker's coach in the morning. If you're reminded in the morning what you have

to do, you're more likely to do it. The higher success rates were in the least restrictive classrooms. That's interesting. We [inaudible] what -- why is that? Well, because in a restrictive

classroom, everything is scheduled. So, I don't need to use my reminder to tell me it's time to go to whatever because the teacher already told me because the whole day is scripted. So, again, least

restrictive makes more success. And the kids were much more socially acceptable and they were included in meaningful interactions. So, this is just a couple little examples of what unintended

consequences were. Now, this is Matt. Matt had his brain injury. He's about 12. And he's also now intellectually challenged which doesn't often happen, but he has both going on for him now. And he

also has what's termed aphasia, which means that he mostly telegraphs his information. And his teacher said do not put him in the study, he'll never learn to spell, and he's going to be a failure at

using this device. So, he came in and this is what he showed us.

>> [inaudible]

>> No school Monday either.

>> Four.

>> Wow. Okay. You guys get [inaudible] all right?

>> Okay. And then...

>> Oh, we'll see. I'm going to get really close here so I can see. Over the weekend, what are you going to do [inaudible]

>> [inaudible] I'll see if I can fix that.

>> So, he finds a spelling error.

>> M-A-N-K [inaudible]

>> [inaudible]

>> [inaudible] watch videos [inaudible]

>> [inaudible] okay [inaudible]

>> Oh, so, he never -- I mean, he found the two Ks.

>> Very good.

>> [inaudible] Sunday.

>> Okay. What's up on Sunday?

>> [indistinct chatter]

>> Then we'll go shopping.

>> [inaudible] go fishing.

>> And then you go shopping.

>> Yes.

>> Sounds like a good plan.

>> Okay.

>> Okay. So, he...

>> How old was he?

>> What?

>> How old was he?

>> He was 14.

>> What'd his teacher say?

>> His teacher actually ended up using the device. She was a good teacher. She ended up using the device with him for all sorts of things. So -- but she didn't -- I mean, she -- until she actually saw

the video, she was amazed. He actually starts spelling -- now, he never did spell smack down correctly but there's nobody that didn't know what he meant. So -- and he found the two Ks and he knew he

misspelled it so we were all happy with that. Now, he went to -- he went on to the cell phone and one of the things we started out going -- okay, you're going to teach to use the contact list and how

to, you know, send information back and [inaudible] stuff back and forth and do all your homework, and blah, blah, blah. And we were using the other parts of the cell phone as a reward. But what we

found was that was backwards because when you said take it home and explore it, they came back -- one girl came back and she had found the camera. And she was taking pictures and going to her

counselor and using the picture as a basis for what she wanted to talk about in counseling. So, there were all of these things starting to emerge that these kids were showing us. So, this is Matt

again. Matt did not live with his mom. He lived with his dad.

>> [inaudible]

>> Like that, probably with your eye.

>> [inaudible]

>> Okay. You ready?

>> Ready.

>> Cover them now.

>> Ready.

>> Okay.

>> Ready?

>> Yeah, what's that?

>> All right. Got that one?

>> [inaudible] oh, my god [inaudible]

>> Yeah, and...

>> Yeah. Got another one.

>> Oh, my gosh.

>> And I found another one.

>> When did you go fishing?

>> Yesterday. I got...

>> So -- okay. So, here he is starting conversation. This is a kid with aphasia who's now initiating conversation based on the pictures and what's going on. And this is the next thing that happened.

&nbsp;

Now, wait a minute.

>> [inaudible]

>> No, we already did that because I went the wrong way.

>> [inaudible]

>> Nice, Matt, I loved it.

>> [inaudible]

>> So, he had sent...

>> [inaudible]

>> Oh, you just got your own pictures.

>> So, he was now communicating with his mother by sending pictures and she was responding back which was the first time he had had that kind of interrelationship with his mother for a long time. So,

lots of unintended benefits that our kids all learned from. And this is John. This is the little boy that you saw earlier. And this is John. Now, John actually became a computer guru. And so he's in

the study and what he's now doing is he's explored enough that now he's teaching the graduate students what they should be doing on the computer, on their phone.

&nbsp;

>> That's a nice side. How did you -- is that how you make the font kind of big?

>> Uh-hmm.

>> Same way that you're showing her?

>> Uh-hmm.

>> Yeah [inaudible]

>> Good [inaudible]

>> You figured that out yourself, how to make it larger?

>> Yeah, I was just working around with it when I heard [inaudible] you know [inaudible] what it's--what it's doing [inaudible]

>> Uh-hmm. So, making the print a larger size is helpful to you?

>> Did you make any other changes so that it was easier for you to read or easier for you to [inaudible]

>> Yeah.

>> I did the [inaudible] dimmer.

>> Okay. So, which one helps you, brighter or dimmer?

>> The [inaudible] one.

>> The [inaudible] one?

>> [inaudible]

>> Okay. But is that [inaudible]

>> No, but if I were to [inaudible]

>> [inaudible] it's the one who serves the power.

>> Uh-hmm.

>> Okay.

>> That's how you serve the power. Okay. If you're interested, there is an intervention plan. It's a four-page brochure that I will email you. You can download it. It is a discussion about what is --

or what are PDA interventions, cell phones, it talks to you a little bit about how to diagnose a kid, because every kid is not a candidate for this. Then it gives you a sample plan, a lesson plan as

to how to do it. And the last page of this intervention, assessment of the teacher and whether or not the teacher thinks it's working and the student themselves. So, if you just email me, I'll be

more than happy to send that to you. And this is Frank. All of us had a favorite person in the study. This was mine so I have to show this to you. This is Andy and Andy had Down Syndrome, but he also

fell and sustained a -- not a concussion, he was in a coma for about a month. And he's another one that we were told do not put him in the study, he will never -- and he never did learn to program

it, but he learned to respond to it. And then one day, we also found out that he had learned to do something else. The Frank in this is Frank Sinatra, and at the beginning, it sounds a little

gravelly, but then it will -- you will hear it after that.

>> [inaudible] to that.

&nbsp;

>> I heard your voice [inaudible]

>> He said that's Frank.

&nbsp;

>> That is Frank.

>> [inaudible] who is Frank?

>> I did that.

>> He said, "I did that."

>> Where did you tape this? Where did you record this?

>> Off your radio?

>> In my radio.

>> Yeah.

>> Excellent. Is this at home?

>> Yeah.

&nbsp;

>> You're so good.

>> I like that one maybe. [inaudible] do this. You recorded this at home?

>> Yeah.

>> Yeah.

>> He did a lot of recording at home.

>> [inaudible]

>> So, I mean, there's a success story for you right there. If he never did another thing other than respond to what somebody else had programmed for him and found a way to use it to make himself

happy, then we've done something really good for this young man. So, I have a lot of other articles and information about the study if you're interested. So, today, we've kind of touched on some

major themes here, mostly that children and adolescents do have cognitive and behavioral effects that impact their learning. And we have to know about those, we have to recognize those and be able to

do something about it. Certainly, the effects of the injury or illness can be long-lasting and may emerge past the time of the events. So, those developmental keys are essential for us to know that

this can be a lifetime of emerging issues and that we need to do something before the issues get much worse, that certainly, now we know that chronic health conditions can develop and that that's

something we need to be able to know and recognize, that certainly our families are impacted and they contribute to outcomes. There's a need for systematic communication between the medical and

community personnel. We still need research on assessment and intervention. We mostly have anecdotal information from our teachers and from other disability areas which tell us what has been

successful and what has not been successful with this population. And we also know that the training of professionals with Interprofessional Education may make a significant difference to our

students and therefore the professionals of the future. I think that's -- oh, well, I just wanted to say that I -- you know, I'm always glad that you're here because you're the ones that go out and

make that difference. You're the ones that go out and tell at least two more people what you learned if you learned something today, then hopefully, there's one or two things that you've learned that

you'd like other people to know. Our kids need you to understand them so that they can be successful rather than fail. And please go and tell two more people what you found out today so that at least

two more people have a better understanding of our kids. So, thank you for your attention and we have a few minutes for questions.